Healthcare Provider Details

I. General information

NPI: 1831686435
Provider Name (Legal Business Name): ABIDING IN THE VINE CARE PROVIDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 WHITNEY AVE BLDG 2
GRETNA LA
70056-5011
US

IV. Provider business mailing address

1141 WHITNEY AVE BLDG 2
GRETNA LA
70056-5011
US

V. Phone/Fax

Practice location:
  • Phone: 504-267-0322
  • Fax: 504-265-0153
Mailing address:
  • Phone: 504-267-0322
  • Fax: 504-265-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BRANDY MARIE CHRISTOPHER
Title or Position: DIRECTOR
Credential:
Phone: 504-267-0322